1598854176 NPI number — RICHARD D. ROBLEE DDS

Table of content: (NPI 1598854176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598854176 NPI number — RICHARD D. ROBLEE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD D. ROBLEE DDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROBLEE ORTHODONTICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598854176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
162 E SUNBRIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72703-2830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-521-6060
Provider Business Mailing Address Fax Number:
479-521-4161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
162 E SUNBRIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-521-6060
Provider Business Practice Location Address Fax Number:
479-521-4161
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBLEE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
479-521-6060

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  2720 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223X0400X , with the licence number: 3412 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14242 . This is a "RDR TEXAS LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 200046150 A . This is a "OK SOONERCARE RDR" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200046160 A . This is a "OK SOONERCARE JML" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 154 . This is a "JML OKLAHOMA LICENSE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: U06567 . This is a "BCBS UPIN" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 155641608 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5F054 . This is a "BCBS GROUP ID #" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 200046140 A . This is a "OK SOONERCARE GROUP ID" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 3412 . This is a "JML ARKANSAS LICENSE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 58127 . This is a "BCBS ID #" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 887681 . This is a "UNITED CONCORDIA ID #" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 2720 . This is a "RDR ARKANSAS LICENSE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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